透明质酸分区域分层次填充矫治眶下区凹陷疗效观察

目的:观察分区域分层次填充透明质酸矫治眶下区凹陷的临床效果。方法:选择2017年4月-2019年1月笔者医院收治的40例眶下区凹陷患者,在局部神经阻滞麻醉或者局部表面麻醉下利用分区域分层次的方法注射透明质酸矫正眶下区凹陷,改善面部老化,然后评价注射后效果与不良反应。结果:本组40例患者注射后对即刻效果均满意,注射后第2天部分患者有轻度肿胀、皮肤发红等现象;8例患者出现局部瘀青,7~10d自行消退;1例患者出现局部泪槽沟加深的现象;2例患者出现局部丁达尔反应。术后有效率达92.5%(37/40)。患者满意度调查,2例患者认为外形欠饱满,未达到自己期望效果;及3例出现不良反应的患者,总体满意率达87.5%(5/40)。术后随访1~6个月,泪槽沟与睑颊沟改善明显,下睑到颧颊区域呈现自然流畅、年轻特征的轮廓曲线,6个月内效果维持满意,部分患者4~6个月进行第二次补充注射。结论:透明质酸分区域分层次注射填充能根据眶下区的解剖特征来选择不同的注射方式进行填充,达到年轻化目的。     

透明质酸注射矫正泪槽畸形

目的 评价应用透明质酸(HA)注射矫正泪槽畸形的临床效果.方法 自2010年6月至2012年6月,对35例矫正泪槽沟畸形患者进行HA注射治疗,注射剂量为0.5～1.5ml.观察注射后的临床效果、疗效时间、不良反应等.结果 所有的注射部位均于注射后即刻得到改善.注射后随访患者,1、3、6个月分别有95.5%、84.7%、52.3%的注射部位维持了改善的效果;6～12个月有43.7%的注射部位维持了改善的效果;12～18个月有15.8%的注射部位维持了改善的效果.注射治疗中,未出现急慢性过敏反应及感染、肉芽肿、血管栓塞等并发症.结论 HA作为暂时性填充剂,治疗泪槽沟畸形安全、可靠.     

经下睑缘切口的睑袋整复术联合眶隔脂肪移植填充泪沟矫治下睑袋伴泪槽畸形

目的:探讨经下睑缘切口的睑袋整复术联合眶隔脂肪移植填充泪沟在下睑袋伴泪槽畸形患者中的应用效果。方法:对2017年12月-2019年1月在医院接受诊治的58例睑袋伴不同程度泪槽畸形患者采用经下睑缘切口的睑袋修复术+眶隔脂肪移植填充泪沟术,术后对患者进行随访,观察和评价手术效果。结果:58例患者均顺利完成手术,术后睑袋和泪槽沟凹陷改善满意,下睑形态自然,无下睑凹陷和眼睑退缩。随访1年,无患者睑袋复发,53例(91.38%)泪沟凹陷改善明显,效果良好,患者满意;另外5例患者(8.62%)泪槽沟改善效果不明显,行自体脂肪移植填充泪沟术后达到满意效果。结论:经下睑缘切口的睑袋整复术联合眶隔脂肪移植填充泪沟具有手术创伤小、操作易掌握和手术效果好等优点,可用于下睑袋伴泪槽畸形患者的修复治疗中。     

胶原蛋白修复透明质酸注射治疗泪睑沟凹陷所致并发症的回顾性研究

目的:探讨胶原蛋白替代透明质酸注射治疗泪睑沟凹陷的效果及预后。方法:选择2015年6月-2017年6月共12例泪睑沟凹陷经透明质酸填充后发生水肿、下睑袋加重、丁达尔现象和条索状隆起等并发症的患者,通过溶解部分透明质酸后注射胶原蛋白进行修复治疗。观察术前、溶酶后、术后患者的泪睑沟凹陷改善情况、并发症的消失情况、"黑眼圈"的改变等变化。结果:注射胶原蛋白后可见透明质酸填充并发症消失,凹陷部位饱满,"黑眼圈"得到明显改善。结论:胶原蛋白注射修复透明质酸注射治疗泪睑沟凹陷后并发症是比较理想的选择,可以避免透明质酸填充引起的并发症,同时可以改善"黑眼圈",值得临床推广。     

注射用透明质酸钠在面部轮廓修饰及年轻化中的应用

目的:探讨注射用透明质酸钠在面部轮廓修饰及年轻化中的临床效果。方法:选取2015年2月-2016年8月笔者医院整形外科进行面部透明质酸纳注射美容的120例就医者为研究对象,其中隆鼻60例、隆颏30例,鼻唇沟填充16例及泪沟填充14例,均在相应部位行透明质酸钠注射治疗,观察注射后的临床效果、不良反应及并发症发生情况,并记录术后即刻、3个月、6个月及12个月的主观满意度评分。结果:四组就医者各时间点的满意度评分随着时间的变化而变化,差异有统计学意义(F=34851.062,P0.05);注射部位与时间点之间存在显著的交互作用(F=27.278,P0.05)。组内不同时间点比较,四组就医者对同一部位治疗后的主观满意度随时间变化均逐渐下降(P0.05)。组间比较结果显示,隆鼻组就医者术后即刻、术后3个月、6个月、12个月的主观满意度显著高于泪沟填充组就医者(P0.05);隆颏组就医者术后3个月主观满意度评分显著高于鼻唇沟填充组、泪沟填充组就医者(P0.05);术后6个月、12个月,隆鼻组和隆颏组的主观满意度评分显著高于鼻唇沟填充组和泪沟填充组(P0.05)。共出现局部胀痛21例,皮肤瘀斑5例,症状均在术后7d内逐步缓解,无其他明显的不良反应和并发症发生。结论:注射用透明质酸钠应用于面部轮廓修饰与年轻化中,效果显著且稳定性高,隆鼻和隆颏治疗效果更显著。     

鼻唇沟透明质酸注射填充术

目的介绍一种应用透明质酸材料注射填充矫正鼻唇沟凹陷的方法。方法采用表面麻醉，应用透明质酸进行双侧鼻唇沟注射填充治疗，每侧用量为1．5～2．0ml，治疗后6个月评价鼻唇沟的改善程度，并记录不良反应。结果本组共33例患者。治疗后复诊均达到理想的鼻唇沟改善效果；随访6个月，鼻唇沟凹陷填充效果仍然存在，局部未发现硬结、红斑、感染、肉芽肿等情况。结论应用透明质酸材料注射填充修复鼻唇沟凹陷是一种非常安全、有效的方法，且效果持久，适宜临床广泛应用。     

梨状孔旁注射透明质酸在面中部年轻化中的应用

目的观察梨状孔旁注射填充透明质酸在面中部年轻化中的应用效果。方法综合分析患者的面部衰老原因,选取面中部容量缺失患者31例,采用梨状孔旁注射填充透明质酸来改善面中部凹陷情况,并观察注射后效果;于注射后第1周及6个月进行随访。结果 31例患者治疗后随访1~6个月,面中部均获得了不同程度的提升,治疗效果较明显,面部轮廓流畅、自然。结论采用梨状孔旁注射填充透明质酸是治疗面中部年轻化的一种安全有效方法,值得临床推广应用。     

透明质酸填充改善面部皱纹的临床疗效

目的评估透明质酸填充改善面部皱纹的临床疗效。方法本组共80例在我院接受透明质酸填充注射治疗面部皱纹的患者,术后患者随访6个月,分析患者术后面部皱纹改善情况、不良反应发生率及患者对治疗效果的满意度。结果 80例患者术后1个月、3个月、6个月面部皱纹改善率分别为93.8%、90.0%和86.3%。所有患者术后出现的局部轻度不良反应均自行消退或在对症治疗后痊愈。所有患者均未出现感染、组织坏死、肉芽肿、血管栓塞等严重不良反应。患者对治疗效果总满意度为93.8%。结论透明质酸填充能明显改善患者面部皱纹,疗效良好,无明显不良反应。     

中胚层疗法联合聚对二氧环己酮面部埋线改善眶周老化的效果

目的观察注射透明质酸填充剂联合聚对二氧环己酮面部可吸收线改善眶周老化的效果。方法收集2017年5月至2019年5月大连市中心医院整形美容科眶周老化女性患者104例, 年龄20～55(36±5)岁。分为轻度组48例、中度组56例。通过注射填充剂和聚对二氧环己酮可吸收线联合治疗改善眶周老化, 治疗后随访6～12个月。结果轻度组在术后即刻满意度明显高于中度组, 且6个月医师评分及患者满意度均高于其他月份。术后6个月, 轻度组满意度评分(7.48±1.29)分, 中度组满意度评分(6.32±1.03)分。随着时间延长两组治疗效果满意度均有不同程度下降。结论依据透明质酸钠凝胶流变学特性及泪沟形成的解剖学特点, 用多点注射填充技术联合小线治疗轻、中度眶周老化, 可获得较好的临床效果。     

透明质酸钠注射治疗老化导致上睑萎缩凹陷及泪槽畸形的中长期疗效观察

目的 观察透明质酸钠局部注射改善老化导致上睑萎缩凹陷及泪槽畸形的中长期临床效果.方法 2017年1—5月,徐州医科大学附属医院整形外科采用透明质酸钠局部注射治疗老化导致上睑萎缩凹陷及泪槽畸形患者108例,术后追踪随访,定期(术后3、6个月,1、2、3年)观察临床效果、患者满意度、不良反应及并发症.结果 本组108例患者...     

Tear trough deformity: review of anatomy and treatment options

The lower eyelid can be a challenging area in facial rejuvenation. While lower eyelid bags are commonly the reason that patients present for lower eyelid rejuvenation, a separate entity known as a tear trough deformity may occur in conjunction with lower eyelid bags or alone. In this article, the authors outline the current understanding of the tear trough anatomy; describe multiple classification systems, which provide an objective means of evaluating the deformity and aid the surgeon in choosing appropriate treatment options; and review surgical and nonsurgical techniques for correcting the tear trough deformity. Treatment options include hyaluronic acid filler, fat grafting, skeletal implants, and fat transposition. Each procedure is associated with advantages and disadvantages, and each should be considered more complex than traditional lower blepharoplasty alone. While lower blepharoplasty removes excess fat and may tighten the anterior lamella, tear trough procedures require the addition of volume to the underlying depression. These procedures requiring release of the ligamentous structures and orbicularis (of which the tear trough is composed), as well as fat transposition or fat grafting, are associated with additional complications, which are also reviewed.     

Long-term preservation of dextranomer/hyaluronic acid copolymer implants after endoscopic treatment of vesicoureteral reflux in children: a sonographic volumetric analysis

PURPOSE: We compared injected volume of dextranomer/hyaluronic acid with sonographic volumes obtained 2 weeks to 36 months postoperatively to evaluate the amount of volume retention with time and to correlate volume retention with voiding cystourethrogram results. MATERIALS AND METHODS: We retrospectively reviewed sonographic volume measurements of dextranomer/hyaluronic acid implants in children at 2 weeks to 36 months postoperatively. Hydronephrosis and percentage of dextranomer/hyaluronic acid retained at each interval were recorded. Average change in volume at each interval was used to compare volume retention with time. The fraction of dextranomer/hyaluronic acid retained was compared to voiding cystourethrogram at 3 months. RESULTS: No patient had new or worsened hydronephrosis. Volumetric data were available for 296, 150, 42, 23 and 20 ureters at 2, 3, 6 and 12 weeks, and 24 to 36 months postoperatively, respectively. Percentage of dextranomer/hyaluronic acid retained was 79% at 2, 74% at 3, 70% at 6 and 78% at 12 weeks, and 65% at 24 to 36 months (p >0.05). While there was no significant difference in mean volume retained between cures (74%) and treatment failures (67%), the 94% cure rate with mega-implants (greater than anticipated volume retention) was higher than that with micro-implants (75%) or nonvisualized implants (70%). CONCLUSIONS: After the initial volume reduction at 2 weeks dextranomer/hyaluronic acid implants remained durable with insignificant volume reduction for up to 36 months postoperatively. Although overall mean volume retention did not correlate with cure, mega-implants were associated with high cure rates and may justify elimination of postoperative voiding cystourethrography.     

3D photography in the objective analysis of volume augmentation including fat augmentation and dermal fillers

The authors present quantitative and objective 3D data from their studies showing long-term results with facial volume augmentation. The first study analyzes fat grafting of the midface and the second study presents augmentation of the tear trough with hyaluronic filler. Surgeons using 3D quantitative analysis can learn the duration of results and the optimal amount to inject, as well as showing patients results that are not demonstrable with standard, 2D photography.     

Case Reports of Adipose-derived Stem Cell Therapy for Nasal Skin Necrosis after Filler Injection

With the gradual increase of cases using fillers, cases of patients treated by non-medical professionals or inexperienced physicians resulting in complications are also increasing. We herein report 2 patients who experienced acute complications after receiving filler injections and were successfully treated with adipose-derived stem cell (ADSCs) therapy. Case 1 was a 23-year-old female patient who received a filler (Restylane) injection in her forehead, glabella, and nose by a non-medical professional. The day after her injection, inflammation was observed with a 3×3 cm skin necrosis. Case 2 was a 30-year-old woman who received a filler injection of hyaluronic acid gel (Juvederm) on her nasal dorsum and tip at a private clinic. She developed erythema and swelling in the filler-injected area A solution containing ADSCs harvested from each patient's abdominal subcutaneous tissue was injected into the lesion at the subcutaneous and dermis levels. The wounds healed without additional treatment. With continuous follow-up, both patients experienced only fine linear scars 6 months postoperatively. By using adipose-derived stem cells, we successfully treated the acute complications of skin necrosis after the filler injection, resulting in much less scarring, and more satisfactory results were achieved not only in wound healing, but also in esthetics.     

关节镜下缝合锚钉加骨隧道缝合方法修复肩袖损伤

目的 探讨肩关节镜下缝合锚钉加骨隧道缝合方法治疗肩袖损伤的手术方法、技巧和疗效.方法 2007年2月-2009年2月,对32例不同类型的肩袖损伤患者,采用关节镜下缝合锚钉加肱骨大结节骨隧道缝合的方法修复肩袖.其中25例全层撕裂,5例滑囊侧部分撕裂,2例关节侧部分撕裂.16例发生于优势侧.术前均拍摄肩关节正位、肩袖出口位X线片,其中11例行MRI检查,21例行MRA检查.全部患者均行肩峰成形与肩峰下滑囊切除,肩袖修复采用单排锚钉固定加经骨隧道穿线缝合18例、双排锚钉加经骨隧道穿线固定14例.按照UCLA肩关节评分标准进行术前和术后功能评估.结果 32例患者获得3～23个月的随访,平均13.4个月.按照UCLA肩关节评分:术前平均为13.3分,术后为33.1分;其中优23例,良9例.术后21例疼痛完全消失,5例偶感轻微疼痛或不适,6例剧烈运动或特殊动作疼痛.24例肩关节活动完全正常.主动前屈及外展角度>150°26例,90°～120°6例.术后前屈及外展肌力M_5 25例,M_47例.所有患者最终对手术效果满意.结论 缝合锚钉加骨隧道穿线缝合是修复肩袖撕裂较好的方法,该技术固定牢靠、保证了肩袖-骨的正常愈合,特别适用于骨质疏松或翻修的病例,值得推广.     

颏部透明质酸注射填充术

目的介绍一种应用透明质酸产品进行颏部注射填充的方法。方法本组共30例颏部短小的患者,在表面麻醉下选用30G细针头进行颏部透明质酸注射填充治疗。透明质酸用量为2．0～3．0m1,平均2．4ml。其中1例患者因颏肌紧张,曾预先行颏肌肉毒毒素注射治疗。治疗后评价颏部填充效果及面部轮廓的改善程度。随访至治疗后6个月。结果本组30例患者,颏部填充后的隆起效果明显,面部轮廓改善,符合审美要求,患者对外观满意。注射治疗后颏部肿胀程度较轻,一般在治疗后第3天达到高峰,在4～7d逐渐消退。未发现外形不对称、局部感染、血肿、皮肤坏死及填充剂过敏情况。填充效果可维持6个月以上。结论应用透明质酸产品注射填充矫正颏部短小,是一种安全、有效的治疗方法,易被医师及患者接受,操作简单,便于推广。     

下颌前沟透明质酸注射填充术

目的探讨透明质酸注射填充修复下颌前沟的临床效果。方法自2010年5月至2013年10月，应用透明质酸对29例求美者进行下颌前沟注射填充，并观察临床效果、维持时间及不良反应。结果本组共29例求美者（共58侧），术后即刻修复效果明显，每侧填充量为0．5～2．0ml，平均0．8ml。维持时间6—8个月。注射后，局部轻微肿胀、皮肤发红，未发生血管栓塞、感染、出血、红斑等并发症。结论透明质酸作为可降解的非活性填充材料，可以安全、有效地修复下颌前沟，改善下颌轮廓。     

面部透明质酸注射不良反应及其防治分析

目的研究面部透明质酸注射的不良反应,综合文献回顾,探讨不良反应的防治方法。方法自2012年1月至2013年12月,对接受透明质酸面部注射的833例患者,在签署知情同意书后,在标准注射室进行精细化注射。采用门诊复查和／或电话随访,记录治疗效果和不良反应。注射部位包括：鼻唇沟218例,隆鼻181例,颞部96例,泪沟93例,隆颏73例,丰唇47例,颧骨内侧脂肪垫46例,眉间22例,额部19例,面颊18例,鼻基底16例,耳垂4例。结果发生局部过度矫正3例,透明质酸注射的位置不满意、不平整5例,血管性水肿8例,急性炎症反应1例,鼻唇沟填充部位发生毛细血管扩张1例,皮下硬结3例。经过保守治疗,症状均得到缓解。结论面部透明质酸注射是安全有效的美容方法;了解注射材料的性质,熟悉操作和解剖,能预防不良反应的产生。     

Improvement of Tear Trough by Monophasic Hyaluronic Acid and Calcium Hydroxylapatite

Tear trough deformities are a sign of facial aging. The anatomical base is well understood. In many patients, minimal invasive surgical procedures are useful to improve appearance. Here, the authors describe the use of monophasic hyaluronic acid dermal filler and calcium hydroxylapatite injection for correction. Forty female patients with a mean age of 50 years have been treated. On average, an improvement of one class of Hidman’s severity score could be achieved by single treatment. Mean duration of the effect was 10.1 months for hyaluronic acid and 12.8 months for calcium hydroxylapatite. Adverse effects were mild and temporary. Patients satisfaction was high (95%).Considering facial aesthetics, the periorbital region is one of the most important regions. Facial aging and loss of volume can be recognized easily due to the delicate structure of periorbital skin and subcutaneous tissue. Tear trough or nasojugal groove describes the concavity at the border of the lower eyelid and medial cheek. This hollow area elicits a tired or wearied appearance. The shadow created by this groove is commonly perceived as dark circles.1The tear trough represents also a border between loose tissue of the lower lid and more compact structures of the cheek. This line or border is defined by an anchoring fascia (septum orbitale) to the periosteum of the inferomedial arcus marginalis. This leads to a separation of adjacent fat compartments of the face—inferior orbital from medial cheek and nasolabial fat pads. In contrast to other prominent facial folds, there is an additional structure separating superficial and deep fat pads—the orbicularis retaining ligament.1 This ligament is stronger in the medial portion, but weaker in the central part. With age, a further weakening can lead to herniation of orbital fat.Recently, Wong et al2 succeeded in isolation and characterization of the tear trough ligament. This is an osteocutaneous ligament found on the maxilla between the palpebral and the orbital parts of the musculus orbicularis. It commences medially just inferior to the anterior lacrimal crest and continues laterally as orbicularis retaining ligament.2In the infraorbital region, the superficial musculo-aponeurotic system (SMAS) consists of a network of small fibrous septae, which traverse perpendicularly between fat lobules to the dermis and deeply into facial muscles or periosteum. Loss of maxillary bone projection negatively affects appearance with increasing age. Severity of tear trough deformity correlates with the anterior angle of the anterior face of maxillary sinus.3,4 Other factors contributing to an aged appearance are loss of skin elasticity, festoons, and musculus orbicularis prominence. The loss of volume indirectly contributes to the tear trough deformity,5,6 which can be associated with lower lid eye bags. The major factors contributing to tear trough deformity can be described by the trinity of relaxation, atrophy, and ptosis. This makes the correction of tear trough deformities one of the most challenging topics for minimal invasive facial aesthetic procedures.7,8Although various surgical techniques have been developed to correct tear trough deformity, non-surgical techniques have gained a wider acceptance by both patients and medical doctors.9,10